Provider Demographics
NPI:1063135242
Name:KROCK, ZACHARY ALBERT (MILITARY HEALTH CARE)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:ALBERT
Last Name:KROCK
Suffix:
Gender:M
Credentials:MILITARY HEALTH CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D MARINE RAIDER BATTALION PSC BOX 20073
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0073
Mailing Address - Country:US
Mailing Address - Phone:916-884-4929
Mailing Address - Fax:
Practice Address - Street 1:3D MARINE RAIDER BATTALION PSC 20073
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0073
Practice Address - Country:US
Practice Address - Phone:916-884-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
1391686943OtherDOD PROVIDER